“It ain’t what you say but the way that you say it”

Known and sung about from 1939 onwards, and beloved of puppy-trainers and parents of toddlers, it’s clear that how we say something is often more important than what we say. And we now know that this is true for how we write down clinical recommendations and indicate the weight of evidence behind them. (When I say know, we have good randomised experimental data to guide us from the excellent @CharlieNeck and @giordanopg, summarised here.)

These innovative clinician-experimenters took a clinical recommendation, and randomised their paediatric colleagues to have the information presented with one of four different ‘grading’ systems. They found the study volunteers differed in their eventual responses … the GRADE system being the strongest change in direction. This supports a wealth of analogous evidence from the field of implementation science, and should make us think very carefully about not just our critical appraisals, but our information presentation too.

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